Treatment of the carotid artery high-grade stenosis in Japan: JCAS

Endo Shunro, Iihara Kouji, Nagata Izumi, Okada Yasusi, Ogawa Akira, Kobayashi Zyunnjiro, Sakai Nobuyuki, Taki Waro, Nagatsuka Kazuyuki, Nagahiro Shinji, Yamada Kazuo, Yamane Kanji, Yoshikawa Kimihiko

doi:10.3995/jstroke.27.492

Randomized trials (NASCET, ECAS, ACAS) have shown absolute benefit of carotid endarterectomy (CEA) for patients with high grade stenosis. For carotid stenting (CAS), safety and efficacy (and durability) as first-choice treatment have not been established. The present prospective, multicenter (not-randermized) trial ; Japan Carotid Atherosclerosis Study (JCAS) has started to analyze present practice and propose treatment guidelines for Japanese patients.<BR>Until the end of September 2004, 1, 013 patients ; 882 males (87%) and 131 female (13%), and mean age was 69.8 years (52-89 years), have been registered. 510 patients (51%) had any neurological symptoms : cerebral stroke (29%), TIA (17%), ocular symptoms (5%), and 503 (49%) patients are asymptomatic. Sixtypercent of these patients had hypertension, 30% had diabetes mellitus and 30% had a previous coronary disease. Sexual difference was not observed in the incidence of thse previous diseases and medical risks.<BR>Of these 1, 014 patients, 444 CEAs (44%) and 317 CASs (31%) were performed. Total complication rate, including neurologic and nonneurologic ones, were 10.6% in CEA and 9, 6% in CAS. Morbidity and mortality rates during one month after surgical treatment were 2.7% (12 cases) in CEA and 3.5% (11 cases) in CAS. Of 12 patients with persistent complication after CEAs, 7 ischemic cerebral symptoms mainly due to distal embolism, 3 hemorrhagic stroke/neurologic deficits due to hyperperfusion syndrome, 2 cranial palsy, and 1 fatal cardiac failure were included. Of 317 CASs, 6 persistent ischemic symptoms due to distal emblism, 2 hemorrhagic stroke, 1 long term hypotention, and 2 technical complication related to angiography were observed.

Treatment of the carotid artery high-grade stenosis in Japan: JCAS

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